Summary & Overview
CPT 33840: Excision of Aortic Stricture with Primary Anastomosis
CPT code 33840 represents open surgical excision of an aortic stricture with primary anastomosis, often used to treat focal aortic narrowing such as coarctation and may include concurrent repair of a patent ductus arteriosus. This procedure is significant nationally because it addresses critical congenital or acquired aortic obstructions that can have major hemodynamic consequences and typically requires inpatient surgical resources and specialized cardiovascular surgical teams.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, typical site-of-service expectations, and a national framing of why accurate coding matters for clinical reporting and hospital billing workflows. The publication also covers common modifier usage and payer coverage patterns where available, benchmarks for utilization and reimbursement when present, and relevant policy considerations that affect surgical cardiovascular coding. Data not available in the input are identified explicitly in the appropriate sections. The content serves as a concise reference for clinicians, coding professionals, and policy analysts seeking to understand the coding and high-level implications of CPT code 33840.
Billing Code Overview
CPT code 33840 describes surgical excision of an aortic stricture with primary anastomosis of the aorta. The procedure involves removing a narrowed segment of the aorta and reconnecting the two healthy ends of the vessel. The description notes that a concurrent repair of a patent ductus arteriosus may be performed if present by ligation or vessel anastomosis.
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Service type: Open vascular surgery of the aorta to correct aortic coarctation or other focal aortic narrowing.
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Typical site of service: Inpatient hospital operating room, with perioperative care in a surgical inpatient setting.
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Clinical & Coding Specifications
Clinical Context
A 4-year-old child presents with signs of upper body hypertension, diminished lower extremity pulses, and an echocardiogram consistent with a discrete aortic coarctation (post-ductal stricture). The pediatric cardiothoracic surgical team evaluates imaging (echocardiography, CT angiography) that confirms a short-segment aortic narrowing just distal to the left subclavian artery, with possible small patent ductus arteriosus. The patient is scheduled for operative correction under general anesthesia in a tertiary pediatric hospital. The procedure performed is surgical excision of the aortic stricture with end-to-end anastomosis (CPT code 33840``). If a patent ductus arteriosus is present intraoperatively, the surgeon may ligate or repair it during the same operation. Typical perioperative workflow includes preoperative cardiology and anesthesia evaluation, placement in the operating room with arterial and central venous monitoring, exposure via thoracotomy or sternotomy per surgeon preference, excision of the narrowed segment, primary reconnection of the aortic ends, hemostasis, closure, and postoperative transfer to pediatric intensive care for hemodynamic monitoring and pain control. Postoperative imaging and blood pressure management are part of routine follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Bundled or institutional use — payer/system specific | Use only when the payer mandates a specific internal designation; rare for professional billing |